3/23 Neuro Flashcards
(113 cards)
1
Q
subthalamic nucleus
- whats it do?
- lesion here causes what?
A
- inhibits movement on the contralateral side of the body.
- Hemiballismus of the contralateral side, or wild, uncontrollable movement of the right arm and leg.
2
Q
Parkinsons
-chemical imbalance?
A
dec. dopamine
inc. ACh
3
Q
Lewy bodies
- seen in what disease?
- composed of what?
A
- Parkinsons, Lewy body dementia
- α-synuclein
4
Q
Huntingtons
- chemical imbalance?
- mnemonic?
A
Expansion of CAG
- Caudate loses ACh & GABA.
- dec. ACh
- dec. GABA
5
Q
Huntingtons
-what causes the neuronal death?
A
-NMDA-R binding and glutamate toxicity.
6
Q
Hemiballismus
-usually caused by what?
A
-lacunar infarct
7
Q
Athetosis
- define:
- seen in what?
A
- Slow, writhing movements; especially seen in fingers.
- damage to basal ganglia (ie. huntingtons).
8
Q
Dystonia
- define:
- examples:
A
- Sustained, involuntary muscle contractions.
- Writer’s cramp; blepharospasm (sustained eyelid twitch).
9
Q
Resting tremor
-what relieves it?
A
-tremor alleviated by intentional movement.
10
Q
Klüver-Bucy syndrome
- wheres the lesion?
- Sxs?
- associated w/which viral infection?
A
- Amygdala (bilateral).
- hyperorality, hypersexuality, disinhibited behavior.
- HSV-1
11
Q
Spatial neglect syndrome (agnosia of the contralateral side of the world).
-wheres the lesion?
A
Right parietal-temporal cortex.
*agnosia = inability to process sensory information.
12
Q
agnosia
-define
A
Inability to process sensory information.
13
Q
Agraphia, acalculia, finger agnosia, and left-right disorientation.
- wheres the lesion?
- whats this disease called?
A
- Left parietal-temporal cortex
- Gerstmann syndrome
14
Q
Reduced levels of arousal and wakefulness (e.g.,coma)
-wheres the lesion?
A
Reticular activating system (midbrain)
15
Q
Wernicke-Korsakoff syndrome
- wheres the lesion?
- mnemonic for Sxs?
- associated w/which vitamin def?
A
Mammillary bodies (bilateral)
- CAN of beer:
- Confusion, Ataxia, Nystagmus.
- thiamine (B1)
16
Q
Damage to cerebellar hemispheres
-contra or ipsilateral deficits?
A
ipsilateral
-fall toward side of lesion.
17
Q
Cerebellar vermis lesion
-Sxs?
A
- Truncal ataxia, dysarthria.
- Vermis is centrally located—affects central body.
- as opposed to cerebellar hemispheres which = laterally located and affect lateral limbs.
18
Q
Paramedian pontine reticular formation lesion
-eyes look toward or away from side of lesion?
A
Eyes look away from side of lesion.
19
Q
Frontal eye fields
-eyes look toward or away from side of lesion?
A
Eyes look toward lesion
20
Q
Central pontine myelinolysis
- aka?
- cause?
- mnemonic?
A
- Ostmotic demyelination syndrome.
- Caused by overly rapid correction of hyponatremia.
- “From low to high, your pons will die” (CPM)
21
Q
Fast dec. in serum sodium
- can cause what?
- mnemonic?
A
“From high to low, your brain will blow”.
-cerebral edema/herniation
22
Q
Central pontine myelinolysis
- Sxs:
- which two tracts are most commonly affects?
A
- Can cause “locked-in syndrome.”
- Acute paralysis, dysarthria, dysphagia, diplopia, and loss of consciousness.
- corticobulbar & corticospinal tracts.
23
Q
dysarthria
-define:
A
Motor speech disorder
-movement deficit. As opposed to aphasia which is a language deficit.
24
Q
Where is the brain is the speech center?
-what artery supplies this area?
A
-Left cerebral hemisphere, in a vascular area supplied by the left middle cerebral artery.
25
Conduction aphasia
- what is it?
- wheres the lesion?
- Poor repetition but fluent speech, intact comprehension.
| - left superior temporal lobe and/or left supramarginal gyrus.
26
Nonfluent aphasia with good comprehension and repetition.
| -whats the disease?
Transcortical motor aphasia
27
Poor comprehension with fluent speech and repetition.
| -whats the disease?
Transcortical sensory aphasia
28
Nonfluent speech, poor comprehension, good repetition.
| -whats the disease?
Mixed transcortical aphasia
29
lenticulostriate
| -off what big artery?
MCA
30
PCA branches off basilar artery at the:
pontomesencephalic junction.
31
brain
- watershed zones
- what Sxs will you see in severe hypotension?
- upper leg/upper arm weakness.
| - defects in higher-order visual processing.
32
```
Therapeutic hyperventilation (brain)
-what is it?
```
When you have acute inc. ICP/cerebral edema:
| -your body hyperventilates, so you dec. pCO2 which leads to vasoconstriction & dec. cerebral perfusion => dec. ICP.
33
MCA stroke
| -Sxs:
- language defects (if in dominant hemo = left hemi).
* contralat. hemineglect if in non-dom side.
- motor/sensory for contralateral upper limb and face.
34
ACA stroke
| -Sxs:
-motor/sensory for contralateral lower limbs.
35
Lenticulo-striate stroke
- what region do they feed?
- Sxs:
- Striatum, internal capsule.
| - Contralateral hemiparesis/hemiplegia.
36
(hemi) paresis =
| (hemi) plegia =
```
paresis = weakness
plegia = paralysis
```
37
fasciculations
| -sign of LMN or UMN lesion?
LMN
38
brisk DTR
| -UMN or LMN lesion?
UMN lesion
39
why does macula get spared in a PCA infarct (which feeds occipital lobe).
Gets collateral blood from MCA.
| *the part of the lobe that processes macular information is what we're talking about.
40
Cystic degeneration of putamen
| -seen in what disease?
Wilson's disease
41
apixaban, rivaroxaban
- mech:
- use:
- directly inhibit factor 10a.
| - Tx & prophylaxis of DVT/PE/stroke.
42
Why is PT so minimally inc. w/heparin admin?
The PT reagent has chemicals that neutralize heparin.
43
Intimate partner violence
| -whats your first step?
- supportive open ended inquiry & identification of emergency safety plans.
* do not pressure the partner to disclose, report the abuse, or leave the partner.
44
Bupropion
| -reuptake inhibitor for which chemicals?
-dopamine & NE.
45
Pain in shoulders & hips then sudden blindness in a 65 year old woman.
polymyalgia rheumatica & temporal arteritis.
46
qualitative study
Using discussion groups, interviews, & other anthropological methods to obtain narrative info that may explain quantitative findings.
47
phenelzine
| -what is it?
nonselective MAO inhibitor
48
TCAs
| -block reuptake of which chemicals?
NE & serotonin
49
Which drugs can cause drug-induced parkinsons?
| -tx:
D2 receptor blockers
- antipsychotics (1st gen>2nd gen)
- anti-emetics (metoclopramide, prochlorperazine).
-Tx: benztropine, diphenhydramine
50
Why can't you use levodopa or dopamine agonists to treat drug-induced parkinsons caused by anti-psychotics?
bc they can induce psychosis.
| -problem was too much dopamine in the first place.
51
fluoxetine
| -what is it?
SSRI
52
imipramine
| -what is it?
TCA
53
Take atropine & sudden eye pain.
| -Dx?
mydriasis = exacerbated angle-closure glaucoma.
54
pramipexole, ropinirole
dopamine agonists
55
neuroblastoma vs wilms tumor
| -which can cross the midline?
neuroblastoma can cross the midline.
56
factitious disorder
- what is its?
- subtypes?
- consciously creating Sxs so you can assume the "sick role" & to get medical attention.
- munchaushen & munchausen by proxy.
57
binge/purge anorexia vs bulimia nervosa
| -difference?
- The anorexic pt has very low BMI & amenorrhea.
| - The bulimic has normal BMI.
58
Conversion disorder
Sudden loss of sensory or motor function s/p acute stressor.
| -chick w/severe weakness in left leg s/p fiance breaking up with her.
59
schizophreniform
| -time frame?
1-6 months
60
Parinaud syndrome
- whats is it?
- cause?
- paralysis of upward gaze.
| - due to lesion in superior colliculi (ie. pinealoma).
61
B12 deficiency
- whats it called?
- what part of spinal cord gets fucked up?
"Subacute combined degeneration"
- dorsal columns
- lateral corticospinal tracts
- axonal degen of periph. nerves.
62
Stroke - ASA (ant. spinal art).
| -whats damaged?
- Lateral corticospinal tract.
- Medial lemniscus.
- Caudal medulla—hypoglossal nerve.
*Dorsal columns spared.
63
Stroke - ASA (ant. spinal art).
| -Sxs:
- Contralateral hemiparesis—upper and lower limbs.
- Dec. contralateral proprioception.
- Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).
64
Stroke - PCA
| -Sxs:
-Contralateral hemianopia with macular sparing.
65
Stroke - Basilar artery
| -Sxs:
- “Locked-in syndrome.”
| - just like Central pontine myelinosis bc basilar artery feeds the pons.
66
Acom
- most common lesion?
- Sxs?
- mnemonic:
Berry aneurysm
- Visual field defects
- "A Com (communications) major must be good w/visuals."
67
PCom
- most common lesions?
- Sxx?
Berry aneurysm
| -CN3 palsy (eye is down and out) w/ptosis & mydriasis.
68
A lesion in which art will => CN 3 palsy?
PCom
69
Central post-stroke pain syndrome
| -where are the lesions?
-Neuropathic pain due to thalamic lesions.
-Initial sensation of numbness and tingling followed in
weeks to months by allodynia and dysaesthesia.
70
allodynia
-ordinarily painless stimuli cause pain.
71
dysaesthesia
-Abnormal, unpleasant sense of touch. Typically w/pain.
72
middle meningeal art = branch of what? which is a branch of what?
External carotid => maxillary art. => middle meningeal a.
73
What type of brain hematoma causes CN3 palsy?
epidural hematoma
74
Epidural hematoma
- can blood cross suture lines?
- can blood cross falx?
- can blood cross tentorium?
- cross suture = no
- cross falx = yes
- cross tentorium = yes
75
Subdural hematoma
- can blood cross suture lines?
- can blood cross falx?
- can blood cross tentorium?
- cross suture = yes
- cross falx = no
- cross tentorium = no
76
Bloody or yellow (xanthochromic) spinal tap
- seen in what?
- what does this predispose to?
-Subarachnoid hemorrhage
-2–3 days afterward, risk of vasospasm due to blood
breakdown and rebleed.
77
Subarachnoid hemorrhage
| -vasospasm, Tx?
nimodipine
78
berry aneurysms
| -lack what layer?
media
79
Ischemic brain disease
| -irreversible damage after how long?
Irreversible damage begins after 5 min of hypoxia.
80
Brain: where is most vulnerable to ischemia?
-hippocampus, neocortex, cerebellum, watershed areas.
81
What scan has highest sensitivity for early brain ischemia?
MRI
82
How long to see ischemia on CT scan?
| -what do you see?
12-24 hrs.
| -dark abnormality.
83
How long after ischemic event do you see red neurons?
12-48 hrs
84
How long after ischemic event do neutrophils show up & necrosis start happening?
24-72 hrs
85
How long after ischemic event do macros show up?
3-5 days
86
How long after ischemic event does reactive gliosis & vascular prolif start?
1-2 weeks
87
How long after ischemic event is there a glial scar?
> 2 weeks
88
Most common site of intracerebral hemorrhage?
basal ganglia
89
hemorrhagic vs ischemic stroke presentation:
-hemorrhagic stroke presents w/acute onset of
focal neuro deficits. Ischemic stroke evolves
over a few hours.
90
Ischemic stroke
| -which is only one that wont be hemorrhagic due to reperfusion?
thrombotic (hypertensive)
- the thrombus is not going to break down.
- keep in mind its a thrombus on top of an atheroma.
91
ischemic stroke
| -Tx:
tPa
92
Dural venous sinuses
| -drain into what vein?
internal jugular vein
93
Lateral ventricle => 3rd ventricle
| -goes thru what?
foramina of monroe
94
3rd ventricle => 4th ventricle
| -goes thru what?
aqueduct of sylvius
| -aka cerebral aqueduct
95
Normal pressure hydrocephalus
- mnemonic?
- clinical triad?
- cause?
"wet, wobbly, & wacky like Mark".
- urinary incontinence, ataxia, and cognitive dysfunction.
- corona radiata distorted by expansion of ventricles.
96
Hydrocephalus ex vacuo
| -cause?
-brain atophy = dec. neural tissue.
97
How many Spinal nerves
| -name the segments & how many there are:
```
-31 total
cervical = 8
thoracic = 12
lumbar = 5
sacral = 5
coccyx = 1
```
98
Do spinal nerves exit above or below the corresponding vertebrae?
- Nerves C1–C7 exit above the corresponding
vertebra. All other nerves exit below.
- so C7 has one nerve exiting above and one below = C7 and C8. Thats where the extra C comes in.
99
Vertebral disc herniation
- whats herniating out of what?
- which direction?
- which levels?
- nucleus pulposus (soft central disc) herniates thru annulus fibrosus.
- usually posterolaterally.
- L4-L5 or L5-S2 = most common
100
Lower border of s. cord?
| Lower border of subarachnoid space?
- s.cord ends at L2
| - subarachnoid space ends at S2
101
Stimulus control therapy
| -what is it?
Leave the room if you cant fall asleep for 20 min.
| -goal = dissociate bedroom from any stimulating activities.
102
normal action potential
| -when is membrane most permeable to K?
- Its not at the peak of the membrane potential, but once the repolarization has already started that the membrane is most permeable to K.
- so not the top of the peak (in the overshoot), but once the cell has already repolarized a bit.
103
primidone
- use?
- what are its metabolites?
- first line med for benign essential tremor.
| - metabolites = phenobarbital phenylethylmalonamide.
104
Upper extremity LMN signs & lower extremity UMN signs in the setting of scoliosis.
+loss of upper extremity pain/temp sensation.
syringomyelia
105
restless leg syndrome
| -tx:
dopamine agonist
| -ie. pamipexole, ropinirole.
106
Middle cerebellar peduncle
- connects what structures?
- landmark for what?
- cerebellum to pons
| - trigeminal nerve (CN 5)
107
Which is the only CN to decussate before innervating its target?
Trochlear nerve.
| -so it innervates the contralateral superior oblique.
108
narcolepsy
- lack of what chemicals in the CSF?
- where are these chemicals made?
- hypocretin 1 (orexin A)
- hypocretin 2 (orexin B)
-made in lateral hypothalamus.
109
Homovanillic acid (HVA)
- breakdown product of what?
- CSF conc. in parkinsons?
- dopamine
| - dec. CSF conc. in parkinsons.
110
CN3
| -courses btwn which arteries as it leaves midbrain?
PCA & SCA (superior cerebellar)
111
thiopental
| -where does it rapidly redistribute to?
skeletal muscle & fat.
112
diphenoxylate
| -what is it?
opiate
113
opsoclonus-myoclonus syndrome
- what is it?
- what disease is it associated with?
- non-rhythmic conjugate eye movement associated w/myoclonus.
- paraneoplastic syndrome associated w/neuroblastoma.
